Hybrid procedures for thoracoabdominal aortic aneurysms and dissections

Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm (TAAA) have recently been proposed as a less invasive alternative to conventional TAAA surgery. This study aimed to evaluate the immediate and long-term outcomes of hybrid procedures for TAAA in high-risk patients.

Between September 1998 and May 2012, 32 high-risk TAAA patients (five females, median age 61.5 years) underwent hybrid procedures at a single institution. Simultaneous approach and staged approach were performed on the basis of patients' conditions. Follow-up computed tomography angiography (CTA) was routinely performed before discharge and at 6, 12 months and annually thereafter.

Procedural success was achieved in all cases. The median hospital stay was (21.5 ± 2.3) days, and the median procedure time was (420 ± 31) minutes. Blood loss averaged (2100 ± 261) ml. A total of 124 visceral artery bypasses was performed. Two patients (6.3%) died within 30 days. One patient exhibited complete paraplegia (3.1%). The visceral graft patency was 96.1% at 3 years. All-cause survival rates were 93.8%, 87.5%, 81.3% and 53.1% at 1, 2, 3 and 5 years, respectively. No patient died due to aortic events. The freedom rates from aortic events were 96.9%, 93.6%, 87.5%, 68.8% at 1, 2, 3 and 5 years, respectively.

The results of visceral hybrid repair for high-risk patients with complex TAAAs are encouraging. However, the procedure is still a significant physiological insult to patients. Until branched and fenestrated endovascular repair become more common, hybrid procedure will continue to have a role in high-risk patients.